Failure of dietetic referral in patients with gastrointestinal cancer and weight loss
Failure of dietetic referral in patients with gastrointestinal cancer and weight loss
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DOI：
10.1016/j.ejca.2006.05.028
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发表时间：
2006-10-01
影响因子：
8.4
通讯作者：
Andreyev, H. J. N.
中科院分区：
文献类型：
--
作者：
Baldwin, C.;McGough, C.;Andreyev, H. J. N.
本研究探讨了在癌症中心工作的工作人员是否经常从门诊病人中识别出胃肠道恶性肿瘤患者，并将其推荐给营养师。营养筛查工具仅用于住院病人。前瞻性记录所有转诊考虑治疗的患者的身高、当前和通常体重。从医院记录中获得与营养师的首次预约、首次入院、人口统计学和临床细节。时间从第一次任命转介到营养师进行了检查。在2002年9月至2004年3月期间，纳入了920例患者。517名患者体重减轻，其中223名患者体重减轻5%至10%，294名患者体重减轻超过发病前体重的10%。327名患者（36%）被转介给营养师。28例（9%）转诊由门诊工作人员进行。299例患者在住院期间或住院后转诊，但其中只有39%发生在住院后的前7天内。三分之一体重减轻超过10%的患者甚至在入院后也没有进行饮食评估。转诊的可能性与体重减轻程度显著相关（单变量分析风险比（HR）1.75，95%置信区间（CI）1.4-2.19，多变量HR 1.65，95% CI 1.22-2.23），并且与体力状态和临床环境等因素无关。很少有患者在治疗的早期被确定为推荐给营养师。由于现在大多数化疗都是在门诊进行的，如果病人不需要住院，他们就不太可能被转诊。这项研究表明，门诊病人的饮食筛选工具是迫切需要的。这种筛查可能会大大改善体重减轻的癌症患者的临床护理。(c)2006爱思唯尔有限公司版权所有。
This study examined whether staff working within a cancer centre treating patients with gastrointestinal malignancy routinely identified individuals from outpatients for referral to a dietitian. A nutrition screening tool is employed only for in-patient admissions. Height, current and usual weight were recorded prospectively in all patients referred for consideration of treatment. First appointment with the dietitian, first hospital admission, demographic and clinical details were obtained from hospital records. Time from first appointment to referral to a dietitian was examined. Between September 2002 and March 2004, 920 patients were included. Five hundred and seventeen patients had lost weight, of whom 223 patients had lost between 5% and 10% and 294 patients had lost more than 10% of their pre-morbid weight. Three hundred and twenty-seven patients (36%) were referred to dietitians. Twenty eight (9%) of referrals were made by staff in outpatients. Two hundred and ninety-nine were referred during or after an inpatient admission but only 39% of these occurred within the first seven days following admission. One third of patients with more than 10% weight loss were not referred for dietary assessment, even following admission. The likelihood of referral was significantly associated with the degree of weight loss (univariate analysis hazard ratio (HR) 1.75, 95% Confidence interval (CI) 1.4-2.19, multivariate HR 1.65, 95% Cl 1.22-2.23) and was independent of factors such as performance status and clinical setting. Few patients were identified early in their treatment for referral to a dietitian. Since most chemotherapy is now given on an outpatient basis, patients are unlikely to be referred if they do not require admission. This study suggests that an out-patient dietetic screening tool is urgently required. Such screening is likely to result in considerable improvements to the clinical care of cancer patients with weight loss. (c) 2006 Elsevier Ltd. All rights reserved.